| NPI | 1518279835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 23309) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 56712) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2023-03-30 |