| NPI | 1366753204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS14077) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102202899) |
| 207Q00000X Family Medicine (Licence: VA 0102202899) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2022-07-21 |