| NPI | 1063049799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NE 33899) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 33899) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2023-03-22 |