NPI | 1619135761 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 55379) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 106011) |
207Q00000X Family Medicine (Licence: MI 4301097920) | |
390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT102803) | |
Enumeration Date | 2008-05-27 |
Last Update Date | 2020-08-18 |