| NPI | 1427779628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 347108) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2022035594) |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2025-06-03 |