| NPI | 1972221349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2026-01593) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2026-03-28 |