| NPI | 1649778929 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101267640) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101267640) |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2024-09-09 |