| NPI | 1285484337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: NV 1285484337) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101028936) |
| 207Q00000X Family Medicine (Licence: NV 1285484337) | |
| Enumeration Date | 2024-03-22 |
| Last Update Date | 2026-08-25 |