| NPI | 1316409063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 88909) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 11471) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2022-08-25 |