| NPI | 1316300965 |
|---|---|
| Former Name | JOSHUA JAMES BOOTH |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2017031727) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: MO 2017031727) |
| 207Q00000X Family Medicine (Licence: MO 2016020823) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2024-03-05 |