| NPI | 1972765592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM A-1633-11) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV SL0564) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2018-12-11 |