| NPI | 1750919916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ R97097) |
| 208D00000X General Practice (Licence: AZ R79097) | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2023-03-30 |