NPI | 1356638811 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME169983) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01077867A) |
207Q00000X Family Medicine (Licence: NV 19520) | |
390200000X Student in an Organized Health Care Education/Training Program | |
207Q00000X Family Medicine (Licence: WI 84493) | |
Enumeration Date | 2011-07-06 |
Last Update Date | 2025-06-06 |