| NPI | 1326336785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS14872) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102203404) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116023685) | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2021-04-20 |