| NPI | 1922788322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN37954) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2026-03878) |
| Enumeration Date | 2023-07-20 |
| Last Update Date | 2026-08-11 |