| NPI | 1497137947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 51252) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R3886) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2024-06-04 |