| NPI | 1003605676 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 1003605676) |
| Enumeration Date | 2025-05-01 |
| Last Update Date | 2025-06-23 |