| NPI | 1669059028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 16910A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0074121) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2025-01-03 |