| NPI | 1821653759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN32752) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL HSE27921) |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2022-04-08 |