| NPI | 1902487119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME168718) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301509566) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2024-08-01 |