| NPI | 1588898597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: DE C1-0009551) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: DE C1-0009551) | |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2013-05-24 |