| NPI | 1356638811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 19520) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01077867A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207Q00000X Family Medicine (Licence: WI 84493) | |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2024-09-16 |