| NPI | 1881905982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 56066) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME137113) |
| 207Q00000X Family Medicine (Licence: CA A-148913) | |
| 207Q00000X Family Medicine (Licence: NY 308363) | |
| 207Q00000X Family Medicine (Licence: WI 67050-20) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2021-06-29 |