| NPI | 1407542384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 011162) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 011162) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2024-08-01 |