| NPI | 1265181192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 97951) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 13716) |
| Enumeration Date | 2022-03-18 |
| Last Update Date | 2024-08-08 |