| NPI | 1285975250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME153605) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301102779) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2022-02-15 |