| NPI | 1861756009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO3352) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A19082) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2023-05-02 |