NPI | 1508508771 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MB12425800) |
Enumeration Date | 2022-04-08 |
Last Update Date | 2024-10-04 |