| NPI | 1063708584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-44189) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 693647) |
| 207Q00000X Family Medicine (Licence: MN 57372) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2017-04-26 |