| NPI | 1487036414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 1908 R75207) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ 1908 R75207) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2021-12-08 |