| NPI | 1396238184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301505557) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A181114) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301115471) | |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2023-02-13 |