| NPI | 1427540566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 05346) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: KY TP989) | |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2025-09-22 |