| NPI | 1821529777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 05424) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 322016) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2023-07-21 |