| NPI | 1063810935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NV DO2633) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CO DR0057649) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2022-11-01 |