| NPI | 1760903801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: KY TP741) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT212820) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2022-07-21 |