| NPI | 1679223143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2025-01781) |
| Enumeration Date | 2022-03-27 |
| Last Update Date | 2026-06-02 |