| NPI | 1043895345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV SL1799) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV SL1799) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2024-01-11 |