| NPI | 1871932970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301103750) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME133252) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2023-11-03 |