| NPI | 1215499975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 332392) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0065851) |
| 207Q00000X Family Medicine (Licence: IL 036.161591) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2024-10-07 |