| NPI | 1104511278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R6681) |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2025-01-03 |