| NPI | 1003161035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 006806) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5315064402) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5315064402) | |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2022-12-05 |