| NPI | 1477848539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0067078) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-16890) |
| 208D00000X General Practice (Licence: HI MD-16890) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2023-03-20 |