NPI | 1376171595 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: NE 2482) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 2482) |
207L00000X Anesthesiology (Licence: NE 2482) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-04-01 |
Last Update Date | 2024-07-30 |