NPI | 1841854031 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 05286) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101025991) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-04-24 |
Last Update Date | 2024-06-28 |