| NPI | 1861194730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 14283553-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0009588) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0009588) | |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2026-05-21 |