| NPI | 1629699210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME166231) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 35482) |
| 207Q00000X Family Medicine (Licence: KY TP317) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2025-04-08 |