| NPI | 1992909766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: OR MD161330) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX N1798) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2020-09-17 |