| NPI | 1912133588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK MEDS7393) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AK 5181) |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2018-03-12 |