| NPI | 1639753049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME166386) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD483220) |
| 207Q00000X Family Medicine (Licence: PA MT224038) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2024-09-29 |