| NPI | 1376986901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-39263) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2014030563) |
| 207Q00000X Family Medicine (Licence: ID 9571555) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-13 |
| Last Update Date | 2025-09-16 |