| NPI | 1184917171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101259628) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD452587) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY R2776) | |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2021-08-18 |