| NPI | 1760943963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 330472) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 330472) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2024-01-05 |