| NPI | 1467030593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: KY R5639) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R5639) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2023-08-07 |