| NPI | 1144854142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC YOUN-GGK3Os) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102206871) |
| Enumeration Date | 2020-02-27 |
| Last Update Date | 2025-04-30 |