| NPI | 1184104218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61305097) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS16258) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO6256) | |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2022-07-13 |