| NPI | 1699094391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-19448) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD164064) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR PG151890) | |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2021-06-02 |