| NPI | 1184851933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 250737) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 241549) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2012-09-13 |