NPI | 1770044646 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: KY 57535) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 57535) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-03-25 |
Last Update Date | 2024-08-27 |