| NPI | 1508120577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO1492) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL l3637r) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2016-11-07 |