| NPI | 1043745276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-81288) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MT Med-Res58975) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2020-06-24 |