| NPI | 1326492489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 019578) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 019578) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 13909-I) | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2022-03-29 |