| NPI | 1184042855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2018011071) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R3656) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2019-07-22 |