| NPI | 1598409781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 38026) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL0009137) |
| Enumeration Date | 2022-04-24 |
| Last Update Date | 2025-07-18 |