| NPI | 1851559488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01073476A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R1978) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207Q00000X Family Medicine (Licence: KY 43682) | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2019-03-04 |