| NPI | 1336899517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.016923) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0075964) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2025-08-11 |