| NPI | 1164999660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ r78887) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R7887) |
| 363A00000X Physician Assistant (Licence: NV PA2058) | |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2022-04-12 |