| NPI | 1467891903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 11197222-1204) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101020701) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MT 58976) | |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2023-11-27 |