| NPI | 1780970897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2015-0371) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 27055) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2015-07-15 |