| NPI | 1194913335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 307204) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA GETP.201428) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2018-03-17 |