NPI | 1770106593 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS022800) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT019914) |
Enumeration Date | 2020-05-27 |
Last Update Date | 2023-08-09 |