| NPI | 1043519796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 64848) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10058334) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2019-04-03 |