| NPI | 1467018903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-02302) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 32884) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2025-06-17 |