| NPI | 1063038388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 90451) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: GA 11688) | |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2024-04-26 |