| NPI | 1386133759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A21215) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 7399) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2023-07-01 |