| NPI | 1811166705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 75129) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP347) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11013951A) | |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2023-04-11 |