| NPI | 1386928281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101257081) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA R-9319) |
| Enumeration Date | 2011-10-11 |
| Last Update Date | 2014-12-11 |