| NPI | 1013443555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1940) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 12127) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2024-05-01 |