| NPI | 1952964330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: UT 12492294-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0007872) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0007872) | |
| Enumeration Date | 2019-04-21 |
| Last Update Date | 2023-03-29 |