| NPI | 1780995035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.098992) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 79366) |
| 207Q00000X Family Medicine (Licence: TX r4285) | |
| 207Q00000X Family Medicine (Licence: NY 300988) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2021-02-10 |