| NPI | 1023878899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 76334) |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2026-03-02 |