| NPI | 1225598980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35.140074) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: OH 35.140074) |
| 208D00000X General Practice (Licence: OK 37326) | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-05-20 |