| NPI | 1043548209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX T3986) |
| Enumeration Date | 2009-11-30 |
| Last Update Date | 2022-05-08 |