NPI | 1063038388 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 90451) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
207Q00000X Family Medicine (Licence: GA 11688) | |
Enumeration Date | 2020-06-23 |
Last Update Date | 2024-04-26 |