| NPI | 1265844625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD202237) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60768409) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2021-01-27 |