| NPI | 1598358913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 23480) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 000762-P.A.) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 16151-I) | |
| Enumeration Date | 2021-02-17 |
| Last Update Date | 2023-08-21 |