| NPI | 1003182205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 66532) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 61526-20) |
| 207Q00000X Family Medicine (Licence: WI 61526) | |
| 207Q00000X Family Medicine (Licence: WI 61526-20) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2023-05-18 |