| NPI | 1174863864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS020544) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT014999) |
| 207Q00000X Family Medicine (Licence: NE 1504) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-02-18 |
| Last Update Date | 2022-03-08 |