| NPI | 1992448807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 06123) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY TP441) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2026-04-28 |