| NPI | 1518282110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-11966) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: STUDENT) |
| 207Q00000X Family Medicine (Licence: CA A120404) | |
| 207Q00000X Family Medicine (Licence: OR MD154424) | |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2021-04-07 |