| NPI | 1710418587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.149822) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH SL458893) |
| 207Q00000X Family Medicine (Licence: CO DR.0064596) | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2025-03-11 |