| NPI | 1538818448 |
|---|---|
| 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: UT 13547791-1204) |
| Enumeration Date | 2022-03-20 |
| Last Update Date | 2025-10-09 |