| NPI | 1700244241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 21609) |
| Additional Taxonomies | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: PR 21609) |
| 208D00000X General Practice (Licence: PR 14030-I) | |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2024-08-29 |