| NPI | 1154860237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: DE C7-0017978) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102205348) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2022-06-26 |