| NPI | 1760019855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL MD.430508) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2021-09-28 |