| NPI | 1336419977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101254432) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OK 30892) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 30892) | |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2021-06-16 |