NPI | 1114307931 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101265166) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101265166) |
Enumeration Date | 2015-06-06 |
Last Update Date | 2023-10-12 |