| NPI | 1083935209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102204903) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA DO-4346) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2019-01-19 |