| NPI | 1730594359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34012356) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101025751) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2023-11-03 |