| NPI | 1467612077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 60373796) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL3222) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 236319) | |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2021-05-10 |