| NPI | 1669050290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 05770) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KY R5643) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2025-06-10 |