NPI | 1770112724 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: OH 35.148420) |
Additional Taxonomies | 208D00000X General Practice (Licence: OH 35.148420) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-04-02 |
Last Update Date | 2024-02-12 |