| NPI | 1326173949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A125127) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 52214-020) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2017-04-10 |