| NPI | 1477117596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301507494) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA ML61068178) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2022-06-22 |