| NPI | 1245893528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: MN 74441) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 75405) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2024-05-09 |