NPI | 1376819151 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME123516) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2012020815) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2012-03-27 |
Last Update Date | 2015-06-29 |