| NPI | 1659514289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101269627) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101269627) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2026-03-19 |