| NPI | 1023638053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM DO2023-0466) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0008373) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0008373) | |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2023-09-26 |