NPI | 1265880520 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16766) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 295215) |
208D00000X General Practice (Licence: AL DO.1791) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-05-27 |
Last Update Date | 2022-09-14 |