| NPI | 1225598808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 56501) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 88628) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2024-01-04 |