| NPI | 1871812800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101261676) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101261676) |
| 207R00000X Internal Medicine (Licence: MA 244919) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 244919) | |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2018-04-10 |