| NPI | 1669048476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 35451) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NE 35451) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2024-07-23 |