| NPI | 1639457260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: MD H89660) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A129432) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301099080) | |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2020-06-30 |