| NPI | 1134658974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 56445-A) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 56445-A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2026-06-10 |