| NPI | 1669053674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM 0000) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NM DO2023-1085) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2023-11-03 |