NPI | 1528588142 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 085757) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101023560) |
Enumeration Date | 2017-06-24 |
Last Update Date | 2020-07-15 |