| NPI | 1649925249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 36277-R) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 35754-R) |
| Enumeration Date | 2022-02-14 |
| Last Update Date | 2024-04-22 |