NPI | 1801580428 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.082464) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.082464) |
Enumeration Date | 2023-06-06 |
Last Update Date | 2023-08-27 |