NPI | 1487214011 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4351044597) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351044597) |
Enumeration Date | 2019-06-17 |
Last Update Date | 2020-02-27 |