| NPI | 1316514599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA OP61359377) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI DOSR-544) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2022-11-29 |