| NPI | 1225597222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101271115) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0101271115) | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2026-05-21 |