| NPI | 1992187132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 273656) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 264750) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2020-02-24 |