| NPI | 1174956049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD190152) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR PG178383) |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2020-10-13 |