NPI | 1730613308 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 81365) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D100800) |
390200000X Student in an Organized Health Care Education/Training Program | |
207Q00000X Family Medicine (Licence: MO 2021037767) | |
Enumeration Date | 2017-04-20 |
Last Update Date | 2025-09-08 |