| NPI | 1932513843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.36770) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 53654) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK P081649867) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2018-04-26 |