| NPI | 1982456133 |
|---|---|
| Former Name | GLENHALL JAMES TAYLOR |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A24733) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101028948) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-04-02 |
| Last Update Date | 2025-12-09 |