| NPI | 1801473319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY R6081) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: MS 37520) | |
| 208000000X Pediatrics (Licence: KY R6081) | |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2026-07-13 |