| NPI | 1184910101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: DE C10010996) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 558502) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2014-10-28 |