NPI | 1184104218 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61305097) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS16258) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO6256) | |
Enumeration Date | 2018-08-17 |
Last Update Date | 2022-07-13 |