| NPI | 1467078576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301509321) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351046706) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351046706) | |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2024-10-21 |