| NPI | 1831359991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.204295) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA PGY.1.LSUBGL-FP) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2016-03-27 |