| NPI | 1821206319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL os10535) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL os10535) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2016-09-01 |