| NPI | 1083319040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL89970) |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2023-07-12 |