| NPI | 1841678844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301509420) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: SC LL38536) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2025-07-30 |