| NPI | 1336501683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 52194) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R3995) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2023-02-08 |