| NPI | 1720577992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2023-00901) |
| Additional Taxonomies | 207ZN0500X Pathology, Neuropathology (Licence: NY 309120) |
| 207Q00000X Family Medicine (Licence: NY 309120) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2023-11-01 |