| NPI | 1497338602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 430151073) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351047566) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2024-10-13 |