| NPI | 1154882561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: KY 56725) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2025-08-19 |