NPI | 1477295541 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME176065) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101286577) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2022-04-10 |
Last Update Date | 2025-10-07 |