| NPI | 1598253379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GU M-2282) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 90167) |
| 207Q00000X Family Medicine (Licence: OH 35.143366) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2022-02-08 |