| NPI | 1871156349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 23166-875) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 67265) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2025-09-30 |