| NPI | 1205362274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 04779) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2022-04-21 |