| NPI | 1114379716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 21440) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 21440) |
| 208D00000X General Practice (Licence: PR 21440) | |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2022-07-14 |