| NPI | 1417418179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A176944) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA PTL157) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2022-07-01 |