| NPI | 1841671872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 14566) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 67475-20) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2023-11-14 |