| NPI | 1851904601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 90235) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: GA 90235) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-08-30 |
| Last Update Date | 2022-11-28 |