| NPI | 1205281292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C203962) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 18872) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2025-08-29 |