NPI | 1316409063 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 88909) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 11471) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-04-02 |
Last Update Date | 2022-08-25 |