NPI | 1124550488 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60964067) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 85197) |
207Q00000X Family Medicine (Licence: NC 2020-03111) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-03-28 |
Last Update Date | 2025-08-01 |