| NPI | 1508201880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 1508201880) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0057179) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2022-10-20 |