| NPI | 1508488818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY R6550) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11023308A) |
| 207Q00000X Family Medicine (Licence: OH 57.257494) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2024-07-22 |