| NPI | 1073795613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0066596) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME102302) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD P19554) | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2009-04-29 |