| NPI | 1821627407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: LA 346663) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1744R1102X Specialist, Research Study | |
| Enumeration Date | 2020-04-05 |
| Last Update Date | 2025-05-29 |