| NPI | 1376882563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 54528) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.34716) |
| 207Q00000X Family Medicine (Licence: KY 54528) | |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2023-04-06 |