| NPI | 1689416141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 102170) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 102170) |
| 208600000X Surgery (Licence: SC Pending) | |
| Enumeration Date | 2024-06-06 |
| Last Update Date | 2026-07-08 |