| NPI | 1649447384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: HI DOSR-127) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD H0093812) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2023-10-31 |