| NPI | 1811212202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-36412) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA R-9239) |
| 207Q00000X Family Medicine (Licence: TX S4603) | |
| 207Q00000X Family Medicine (Licence: MO 2018014203) | |
| 207Q00000X Family Medicine (Licence: OK 8460) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2024-05-14 |