| NPI | 1598498354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT230221) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 9327) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2023-11-05 |