| NPI | 1811258866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA 0S017436) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT014517) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2024-04-15 |