NPI | 1629642616 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10076933) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V0762) |
Enumeration Date | 2021-05-14 |
Last Update Date | 2024-07-19 |