| NPI | 1679323190 |
|---|---|
| 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: VA 0101288472) |
| Enumeration Date | 2024-03-26 |
| Last Update Date | 2026-08-20 |