| NPI | 1114412251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL OS16461) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO6096) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2021-11-02 |