NPI | 1376287037 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351049140) |
Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301513799) |
Enumeration Date | 2022-04-27 |
Last Update Date | 2025-07-25 |