| NPI | 1932584224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OH 34.013978) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT016819) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2023-04-19 |