| NPI | 1700456340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: KY 61604) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-06-27 |
| Last Update Date | 2026-07-01 |