| NPI | 1326798901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R79086) |
| 208D00000X General Practice (Licence: AZ R79086) | |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2023-05-15 |