| NPI | 1295589976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NE 37043) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MS 35594) |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2026-06-10 |