| NPI | 1518311034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY R4621) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101023572) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY R4621) | |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2021-11-22 |