| NPI | 1063650844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY Elias1421) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A122000) |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2013-12-02 |