| NPI | 1316197668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME114294) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 47075) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10028868) | |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2013-04-05 |