| NPI | 1437045127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 101692) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 101692851) |
| Enumeration Date | 2025-06-17 |
| Last Update Date | 2025-07-31 |