NPI | 1386132330 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T5174) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35140120) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-04-25 |
Last Update Date | 2024-09-19 |