| NPI | 1124550488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-03111) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 85197) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2021-02-22 |