| NPI | 1215477955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A160928) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A160928) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2023-06-08 |