| NPI | 1851822696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 85842) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R4541) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY R4541) | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2021-01-21 |