NPI | 1700506201 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2022026954) |
Enumeration Date | 2022-09-02 |
Last Update Date | 2024-07-10 |