| NPI | 1770112724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: OH 35.148420) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35.148420) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2025-05-05 |