NPI | 1619506979 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D98444) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD600001864) |
207Q00000X Family Medicine (Licence: FL 156122) | |
390200000X Student in an Organized Health Care Education/Training Program | |
207Q00000X Family Medicine (Licence: VA 0101279871) | |
Enumeration Date | 2020-04-07 |
Last Update Date | 2025-04-11 |