| NPI | 1578982971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2017038287) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20a17474) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM AB7003469-B1708) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2023-07-05 |