| NPI | 1962070177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2021019247) |
| 207R00000X Internal Medicine (Licence: AZ R79227) | |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2023-04-30 |