| NPI | 1134380710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A11612) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2083A0100X Preventive Medicine Aerospace Medicine (Licence: WI 53581-021) | |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2015-07-29 |