| NPI | 1255892196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101275185) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT221644) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2025-07-25 |