| NPI | 1083354039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 2171959) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R6281) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2025-09-18 |