NPI | 1164981122 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OT019045) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT019045) | |
Enumeration Date | 2019-03-18 |
Last Update Date | 2022-06-13 |