| NPI | 1497288146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-43669) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2017020779) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2024-03-27 |