| NPI | 1881198760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TN 66485) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101267869) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2023-06-05 |