| NPI | 1477670198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 41476) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ME EC061040) |
| 207Q00000X Family Medicine (Licence: NV 12990) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2013-04-17 |