| NPI | 1629631866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 92025) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 29876) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2023-12-19 |