| NPI | 1073193975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 1.076102-DO) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: CT 20835001) | |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2024-07-26 |