| NPI | 1518658624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 79646) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: AZ 79646) | |
| Enumeration Date | 2023-05-18 |
| Last Update Date | 2026-06-25 |