| NPI | 1922531458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 57052) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY TP934) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2022-09-28 |