| NPI | 1144608035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0059483) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.132158) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2022-12-12 |