NPI | 1356924831 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 23045) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.017089) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-05-03 |
Last Update Date | 2024-09-22 |