| NPI | 1164951752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 97334) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 1913) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2023-10-05 |