NPI | 1740660414 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2019-00872) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101263777) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116027952) | |
Enumeration Date | 2015-06-08 |
Last Update Date | 2021-09-07 |