| NPI | 1437558111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 17273) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-128957) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2024-06-18 |