| NPI | 1568975977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0095315) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL82578) |
| 207Q00000X Family Medicine (Licence: PA MD479418) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2023-10-05 |