| NPI | 1780370866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL L.3853) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: SC LL89764) |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2024-10-22 |