| NPI | 1225897861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2025051884) |
| Enumeration Date | 2024-03-18 |
| Last Update Date | 2026-03-11 |