| NPI | 1477110724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.015971) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101025979) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2022-09-09 |