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 |