| NPI | 1821357591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2019-02186) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 208247) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2020-01-29 |