| NPI | 1427407360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16871) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125068108) |
| 207Q00000X Family Medicine (Licence: CO DR0062188) | |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2020-06-19 |