NPI | 1720616022 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX U6422) |
Enumeration Date | 2020-03-31 |
Last Update Date | 2023-09-12 |