| NPI | 1407350556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 72500-21) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 290387) |
| 207Q00000X Family Medicine (Licence: MA T290387) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2025-12-31 |