| NPI | 1033841101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV SL1890) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NV DO3792) |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2025-01-19 |