| NPI | 1639730799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 18008) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 74223-20) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2022-08-07 |