| NPI | 1598933012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP 60415441) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02003432A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2015-06-17 |