| NPI | 1730613308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D100800) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: MO 2021037767) | |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2024-09-19 |