NPI | 1104327857 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101268517) |
Enumeration Date | 2018-02-27 |
Last Update Date | 2023-08-28 |