| NPI | 1144925777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 38039) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301512643) |
| 207Q00000X Family Medicine (Licence: CO 73845) | |
| 207Q00000X Family Medicine (Licence: GA 101353) | |
| 207Q00000X Family Medicine (Licence: MN 77878) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2024-10-25 |