| NPI | 1295290781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 32944) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60984839) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NE 32944) | |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2024-12-04 |