| NPI | 1649631573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 94332) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 60010) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL MD.37104) | |
| Enumeration Date | 2016-03-20 |
| Last Update Date | 2026-08-13 |