| NPI | 1245766237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS17020) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 86442) |
| 207P00000X Emergency Medicine (Licence: FL OS17020) | |
| 207Q00000X Family Medicine (Licence: GA 86442) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2020-10-16 |