| NPI | 1700366408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO.2112) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL L.4796R) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2025-06-02 |