| NPI | 1336383553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 16851) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH RT2167) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2014-11-13 |