NPI | 1518589894 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: MI 5101026620) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101026620) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-05-10 |
Last Update Date | 2024-01-24 |