| NPI | 1548422769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR E6555) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR e6555) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: AR E6555) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-29 |
| Last Update Date | 2025-07-22 |