| NPI | 1124777636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: SC 94666) |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2026-03-08 |