| NPI | 1740909944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 82565-20) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 9806-851) |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2025-09-20 |