| NPI | 1255438586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60180279) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ME EC081117) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-03-31 |