| NPI | 1063999340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A165662) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA A165662) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2025-10-31 |