| NPI | 1730310772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 51820) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 34710) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2021-10-11 |