| NPI | 1205098985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 46842) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 31944) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2017-05-04 |