| NPI | 1811285174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME146985) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301099452) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301099452) | |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2020-11-09 |