| NPI | 1376120329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 05591) |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2024-05-29 |