| NPI | 1831484591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60732099) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-36185) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2021-06-04 |