| NPI | 1073317970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RTL26-0947) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 35378) |
| Enumeration Date | 2025-04-02 |
| Last Update Date | 2026-07-13 |