| NPI | 1902549041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 14204275-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 204-t1) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-17 |
| Last Update Date | 2025-07-16 |