| NPI | 1093997645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2011-01595) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME102888) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD P19555) | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2021-05-10 |