NPI | 1871185710 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101276066) |
Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101276066) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-02-10 |
Last Update Date | 2024-06-25 |