NPI | 1902484017 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: AL DO.3055) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
207Q00000X Family Medicine (Licence: MS 33419) | |
Enumeration Date | 2021-03-30 |
Last Update Date | 2024-10-28 |