| NPI | 1902398829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 93919) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 84006) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2025-06-18 |