| NPI | 1790803153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101245474) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301083474) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301083474) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2013-02-19 |