| NPI | 1063120707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 53028) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL L.6110R) |
| Enumeration Date | 2022-11-11 |
| Last Update Date | 2026-05-15 |