| NPI | 1518727403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GU TLL-2026-009) |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2026-05-11 |