NPI | 1376234583 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: PR 023927) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 16523-I) |
Enumeration Date | 2023-05-18 |
Last Update Date | 2024-08-06 |