| NPI | 1407379746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN 4634) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TN 104) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2022-07-21 |