| NPI | 1174986087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61026142) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 52855) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2020-10-26 |