| NPI | 1730422445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 56024) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: NY 286010-1) | |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2021-06-29 |