| NPI | 1922741248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2024016069) |
| 208D00000X General Practice (Licence: KS 95-00048) | |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2024-10-21 |