| NPI | 1639298318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: CT 047485) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301083650) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301083650) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2009-04-14 |