| NPI | 1881273415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MD493909) |
| 208D00000X General Practice (Licence: MI 4301516023) | |
| 208D00000X General Practice (Licence: OH 35.155317) | |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2026-02-14 |