| NPI | 1871921551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS019722) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA DO-04963) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2022-09-21 |