| NPI | 1700220027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 03834) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R3277) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2018-04-04 |