| NPI | 1831337930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 137375) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 036.126363) |
| 207Q00000X Family Medicine (Licence: IL 036126363) | |
| Enumeration Date | 2009-01-27 |
| Last Update Date | 2020-09-10 |