| NPI | 1881043016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H87705) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 217770) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2022-11-08 |