| NPI | 1558778274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A18498) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO3957) |
| 207Q00000X Family Medicine (Licence: MN 62269) | |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2022-10-21 |