NPI | 1174984066 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A156941) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
207Q00000X Family Medicine (Licence: FL ME157818) | |
Enumeration Date | 2016-03-19 |
Last Update Date | 2022-09-13 |