NPI | 1558949578 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 75606) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036175061) |
207Q00000X Family Medicine (Licence: NC 2024-02134) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-03-31 |
Last Update Date | 2025-07-10 |