| NPI | 1740771252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 1021331339) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125072103) |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2021-08-25 |