NPI | 1053545285 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 174400000X Specialist (Licence: CA A95140) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A95140) |
Enumeration Date | 2009-05-01 |
Last Update Date | 2022-02-11 |