| NPI | 1417158767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301102418) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 047380) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2018-10-14 |