| NPI | 1851978118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 78016) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MDRE.ML.61162088) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2024-06-05 |