| NPI | 1831693985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 57267) |
| Additional Taxonomies | 207QS1201X Family Medicine, Sleep Medicine (Licence: KY 57267) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2024-06-03 |