| NPI | 1205619301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 100789-851) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11023877A) |
| 208D00000X General Practice (Licence: AZ R80151) | |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2024-06-28 |