| NPI | 1255955159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT221145) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND PT20162) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2023-10-02 |