| NPI | 1548957277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 101076) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 15556) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-21 |
| Last Update Date | 2025-12-02 |