| NPI | 1487188587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 86062) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101024542) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2020-09-02 |