| NPI | 1336860782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 23528) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16045I) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 23582) | |
| Enumeration Date | 2022-09-05 |
| Last Update Date | 2025-11-17 |