| NPI | 1285189464 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 99484) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 68992) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2025-02-18 |