| NPI | 1083092282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 19017) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116028206) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2018-07-13 |