| NPI | 1871160820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT222565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 8313520) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2024-03-07 |