| NPI | 1821527292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 04823) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151012371) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2022-07-21 |