NPI | 1871057828 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101270352) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101270352) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-01-23 |
Last Update Date | 2024-07-02 |