| NPI | 1467938449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A182157) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA11037500) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301115134) | |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2025-04-29 |