| NPI | 1871988469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OK 7246) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101021945) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2021-08-20 |