| NPI | 1497246342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A23379) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS021503) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT018280) | |
| Enumeration Date | 2018-05-27 |
| Last Update Date | 2025-02-19 |