| NPI | 1124608500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61576431) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA PTL8072) |
| 207Q00000X Family Medicine (Licence: CA A196554) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-10 |
| Last Update Date | 2024-09-04 |