NPI | 1164981015 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.146028) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.247181) |
Enumeration Date | 2019-03-19 |
Last Update Date | 2022-07-16 |