| NPI | 1154702926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD26093) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101260850) |
| 207Q00000X Family Medicine (Licence: CA 160257) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2022-09-21 |