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 |