| NPI | 1730685553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-44413) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS 94-09599) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2022-06-16 |