NPI | 1821741000 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: PR 023775) |
Additional Taxonomies | 208D00000X General Practice (Licence: FL 1634) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2022-01-28 |
Last Update Date | 2024-09-11 |