| NPI | 1669828133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2019-0636) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0065535) |
| 207Q00000X Family Medicine (Licence: OH 35.140914) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 0) | |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2020-11-25 |