| NPI | 1033303821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 064251) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.29968) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2022-08-07 |