| NPI | 1760006647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 23073) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 23073) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2025-10-07 |