| NPI | 1356911200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A194193) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2021-0706) |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2024-07-09 |