| NPI | 1932939121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 24212) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 543) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 16876I) | |
| Enumeration Date | 2024-08-03 |
| Last Update Date | 2025-01-28 |