| NPI | 1447704234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 19974) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 32630R) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2018-06-26 |