| NPI | 1689203788 |
|---|---|
| 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: CO 0072899) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2024-07-03 |