| NPI | 1518306372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 21697) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2018-0572) |
| 207Q00000X Family Medicine (Licence: HI MD-22052) | |
| 207Q00000X Family Medicine (Licence: CA A175757) | |
| 208D00000X General Practice (Licence: IN 01074306A) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT203458) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2022-09-29 |