| NPI | 1356028336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 24042) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 16614-I) |
| Enumeration Date | 2023-06-30 |
| Last Update Date | 2024-07-31 |