NPI | 1215438221 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102206797) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 1846651) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-02-24 |
Last Update Date | 2022-07-13 |