| NPI | 1801087861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2013023689) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125053634) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: VA 0101256401) | |
| 207Q00000X Family Medicine (Licence: VA 0101256401) | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2016-08-23 |