| NPI | 1669919528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 19523) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19523) |
| 282N00000X General Acute Care Hospital (Licence: PR 19523) | |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2025-01-09 |