| NPI | 1447561022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 68260) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 068260) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2025-02-24 |