| NPI | 1770080574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 04968) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 04968) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2021-07-06 |