| NPI | 1841854031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 05286) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101025991) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2024-06-28 |