| NPI | 1750962221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 77069) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 192751) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 192751) | |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2024-06-18 |