| NPI | 1629645320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 77122) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11021505A) |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2024-09-03 |