| NPI | 1255713475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-01984) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 65680) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2022-06-21 |