| NPI | 1962065334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 58856) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KY TP832) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-20 |
| Last Update Date | 2024-05-30 |