| NPI | 1902363971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101270242) |
| Additional Taxonomies | 2865X1600X Military Hospital, Military General Acute Care Hospital. Operational (Transportable) (Licence: VA 0101270242) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-02-26 |
| Last Update Date | 2023-11-21 |