| NPI | 1912574377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 010846) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT020864) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R4167) | |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2024-07-12 |