| NPI | 1073048138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16681) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS019901) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT017644) | |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2022-11-09 |