NPI | 1174144125 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS20548) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OTo20403) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-04-30 |
Last Update Date | 2024-10-10 |