| NPI | 1841829728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1910) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102207295) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2024-07-08 |