| NPI | 1639829377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC HEND-GK3L8H) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC HEND-GK3L8H) |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2023-03-29 |