| NPI | 1740779065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 19278) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 6607) |
| 207Q00000X Family Medicine (Licence: OK 0667) | |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2022-10-18 |