| NPI | 1508326802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 1508326802) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NC 1508326802) |
| 208D00000X General Practice (Licence: NC 202003666) | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2024-03-17 |