| NPI | 1407737000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10099298) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2025032669) |
| Enumeration Date | 2025-09-10 |
| Last Update Date | 2026-05-22 |