| NPI | 1568811842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 04539) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 218763) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2022-03-14 |