NPI | 1144712639 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61144305) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
207Q00000X Family Medicine (Licence: WA MD.MD.61144305) | |
Enumeration Date | 2018-05-31 |
Last Update Date | 2023-04-27 |