NPI | 1811648900 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: PR 022984) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 15845-I) |
Enumeration Date | 2022-01-11 |
Last Update Date | 2023-09-29 |