NPI | 1124762596 |
---|---|
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: MI 4301510742) |
Enumeration Date | 2022-04-22 |
Last Update Date | 2023-12-26 |