| NPI | 1669731741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2020038633) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 59060) |
| 207Q00000X Family Medicine (Licence: ND 13580) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2020-12-31 |