| NPI | 1891355293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MA 1013913) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OT019160) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT019160) | |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2026-03-13 |