| NPI | 1801572474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 23814) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 36374R) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2026-06-15 |