| NPI | 1619506979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D98444) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD600001864) |
| 207Q00000X Family Medicine (Licence: FL 156122) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207Q00000X Family Medicine (Licence: VA 0101279871) | |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2025-04-11 |