NPI | 1275321655 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO10423) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO10423) |
Enumeration Date | 2025-04-28 |
Last Update Date | 2025-06-03 |