| NPI | 1760172563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 37439) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ND RL19707) |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2026-07-02 |