NPI | 1326676511 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 331371) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 331371) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-04-01 |
Last Update Date | 2023-06-01 |