| NPI | 1205178464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A170433) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-9986) |
| 207Q00000X Family Medicine (Licence: OH 35.145200) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2025-03-06 |