NPI | 1447882436 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351052318) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 23375) |
Enumeration Date | 2020-02-07 |
Last Update Date | 2024-06-10 |