NPI | 1831830892 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 60888) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R6360) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2022-04-05 |
Last Update Date | 2025-06-19 |