| NPI | 1770015521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 81927) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.38783) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 81927) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2020-06-03 |