| NPI | 1093465692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0009167) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO PENDING) |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2022-07-01 |