NPI | 1407596414 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 390200000X) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 390200000x) |
Enumeration Date | 2022-03-29 |
Last Update Date | 2022-03-29 |