| NPI | 1215645924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 101614) |
| Enumeration Date | 2022-11-10 |
| Last Update Date | 2024-08-31 |