| NPI | 1952981011 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC DO210012556) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD H0104314) | 
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0102209247) | |
| 208D00000X General Practice (Licence: FL OS20269) | |
| Enumeration Date | 2021-04-13 | 
| Last Update Date | 2025-08-02 |