| NPI | 1053060988 |
|---|---|
| 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: OR DO222057) |
| Enumeration Date | 2022-03-19 |
| Last Update Date | 2025-02-01 |