| NPI | 1538295845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 43434) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 43434) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2024-08-30 |