| NPI | 1811195787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OR md158313) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR ll16317) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2023-11-07 |