| NPI | 1306372909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 66347) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 28508) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2023-05-12 |