| NPI | 1518652742 |
|---|---|
| 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: NC 2024-02563) |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2024-10-27 |