NPI | 1174985535 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 57.027997) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60943571) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-03-24 |
Last Update Date | 2025-05-23 |