| NPI | 1881012664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD56137) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R3573) |
| 207Q00000X Family Medicine (Licence: KY 49435) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2022-07-21 |