| NPI | 1750600573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2013021845) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: WA MD60296626) | |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2013-08-28 |