| NPI | 1891958054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 47516) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: OH 35.129578) | |
| 207R00000X Internal Medicine (Licence: PA MD446923) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2016-12-16 |