| NPI | 1275828121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 269255) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: AK MEDS8287) | |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2018-10-04 |