| NPI | 1417659160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A197207) |
| 208D00000X General Practice (Licence: IL 036.177031) | |
| 208D00000X General Practice (Licence: FL ME1777341) | |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2025-11-14 |