| NPI | 1649455601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 103943) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301085736) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301085736) | |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2024-04-01 |