| NPI | 1043604614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 1609) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NE 1609) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2018-07-20 |