| NPI | 1689369332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO3967) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV SL2025) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2025-10-07 |