NPI | 1407318041 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 19658) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 19966) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-04-02 |
Last Update Date | 2023-05-22 |