| NPI | 1467652347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 90357) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301085593) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301085593) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2023-01-25 |