| NPI | 1467940882 |
|---|---|
| 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: MO 2018008811) |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2019-05-07 |