| NPI | 1851749964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 19835) |
| 208D00000X General Practice (Licence: PR 19835) | |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2022-03-27 |