| NPI | 1295410017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV SL2097) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NV DO4050) |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2026-03-02 |