NPI | 1740735828 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY P00712) |
Additional Taxonomies | 208D00000X General Practice (Licence: PA MD457121) |
Enumeration Date | 2016-08-18 |
Last Update Date | 2016-08-18 |