| NPI | 1447831342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL86120) |
| 207Q00000X Family Medicine (Licence: NC 2024-00324) | |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2024-05-22 |