NPI | 1740719640 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 1740719640) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 64365) |
Enumeration Date | 2017-06-06 |
Last Update Date | 2021-11-12 |