| NPI | 1659114239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC RTL24-1026) |
| Enumeration Date | 2024-06-13 |
| Last Update Date | 2024-09-19 |