| NPI | 1265886733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 4301119227) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301119227) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2024-07-29 |