NPI | 1902427503 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: PR 35091) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 314627) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-05-05 |
Last Update Date | 2023-12-12 |