| NPI | 1932337185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101253434) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301094992) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301094992) | |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2023-11-27 |