| NPI | 1912206020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD487080) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 26477) |
| 207R00000X Internal Medicine (Licence: ND 12803) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: ND RL11495) | |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2024-11-06 |