NPI | 1366948002 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 208D00000X General Practice (Licence: CA 17524) |
Enumeration Date | 2018-04-02 |
Last Update Date | 2021-06-01 |