| NPI | 1902148729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301109167) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 301388) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301109167) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2022-06-06 |