| NPI | 1841697174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: DC MD048663) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC 002616) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC 2616) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC MTL002616) | |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2022-03-12 |