| NPI | 1740866441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD D0102446) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V5601) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2026-04-05 |