| NPI | 1437687803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NE 35380) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 35380) |
| 208D00000X General Practice (Licence: WA OP60881953) | |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2023-07-20 |