| NPI | 1851825509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101271716) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2020-00601) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 227081) | |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2025-08-28 |