NPI | 1396127411 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QS1000X Clinic/Center, Student Health |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2901021602) |
Enumeration Date | 2015-06-25 |
Last Update Date | 2017-06-17 |