| NPI | 1730875683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C2-0024988) |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2026-06-24 |