| NPI | 1598897761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 14818) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: NC 2011-01224) | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2026-08-28 |