| NPI | 1134410384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 51435) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2015-00471) |
| 207Q00000X Family Medicine (Licence: PA MD450976) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2022-07-21 |