| NPI | 1912460734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GU M-2326) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 69334) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2023-01-11 |