| NPI | 1548013204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 1548013204) |
| Enumeration Date | 2024-04-10 |
| Last Update Date | 2026-06-15 |