| NPI | 1639602071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD210002623) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY S03-009-797) | |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2022-08-29 |