| NPI | 1841828894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 11685) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 1) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2022-02-17 |