| NPI | 1174081707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101270192) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101270192) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0101270192) | |
| Enumeration Date | 2019-03-02 |
| Last Update Date | 2023-07-05 |