NPI | 1942793195 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-45102) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 146-T2) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-06-12 |
Last Update Date | 2022-03-31 |