| NPI | 1356034714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 011604) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ 011604) |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2025-05-07 |