| NPI | 1184298523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 34.017261) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL83595) |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2024-05-31 |