| NPI | 1699333179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 91203) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101274274) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2023-02-17 |