| NPI | 1457730855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 010766) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 69257) |
| 207Q00000X Family Medicine (Licence: IL 036144438) | |
| 207Q00000X Family Medicine (Licence: NM A-2495-21) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2024-02-19 |