| NPI | 1578212197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL L.5757R) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL -----------) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2022-08-31 |