| NPI | 1730420399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 15903) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58.007264) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2018-01-18 |