| NPI | 1356835243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 20A17818) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: CA 20A17818) | |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2023-07-13 |