| NPI | 1366736373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD164784) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR PG155510) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2021-02-15 |