| NPI | 1457704322 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PR 21435) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 21435) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2021-11-17 |