| NPI | 1275096489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA 20A19826) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 05052) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 05052) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 19826) | |
| Enumeration Date | 2019-04-13 |
| Last Update Date | 2023-09-21 |