| NPI | 1639743180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 86291) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL86291) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2025-08-06 |