NPI | 1164923363 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: PR 6140323) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 6140323) |
Enumeration Date | 2018-02-22 |
Last Update Date | 2020-04-16 |