NPI | 1851952618 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V9410) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301506416) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351044485) | |
Enumeration Date | 2019-06-24 |
Last Update Date | 2025-07-22 |