| NPI | 1710689484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 4581204) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: UT 14151351-1205) | |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2026-06-30 |