| NPI | 1518460575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY TP395) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: KY 57597) | |
| 207Q00000X Family Medicine (Licence: KY R5581) | |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2023-11-03 |