| NPI | 1386273654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY R5422) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 57034) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2023-11-14 |