| NPI | 1548612815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301110632) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301110632) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2016-11-02 |