NPI | 1265753974 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 335571) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A157721) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2010-06-16 |
Last Update Date | 2025-06-16 |