NPI | 1417330606 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL OS14140) |
Additional Taxonomies | 208D00000X General Practice (Licence: FL OS14140) |
Enumeration Date | 2015-07-07 |
Last Update Date | 2023-03-03 |