| NPI | 1316459076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 55784) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 55784) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2021-11-10 |