| NPI | 1003328808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 22423) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15588-I) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2021-08-17 |