| NPI | 1194308643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-49984) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0008700) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2024-10-23 |