| NPI | 1124657838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-46144) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS pending) |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2022-10-27 |