| NPI | 1376287037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351049140) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301513799) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2025-07-25 |