| NPI | 1023470259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 144540) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY COVID-19) |
| 207R00000X Internal Medicine (Licence: KY 56933) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207R00000X Internal Medicine (Licence: MA 278650) | |
| Enumeration Date | 2016-03-26 |
| Last Update Date | 2022-07-22 |