| NPI | 1851515365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO180235) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60479165) |
| 207Q00000X Family Medicine (Licence: ID OC-0054) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2021-04-08 |