| NPI | 1073929600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 1073929600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI XXX) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2015-06-15 |