| NPI | 1144421504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 064592) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN 10258) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2016-09-26 |