| NPI | 1780312496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 3966) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL L.5788R) |
| Enumeration Date | 2022-08-10 |
| Last Update Date | 2025-06-17 |