| NPI | 1063945152 |
|---|---|
| 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: OH 35.139855) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2021-12-27 |