| NPI | 1417511205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A181652) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD49719) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA R-11693) | |
| Enumeration Date | 2019-04-26 |
| Last Update Date | 2022-10-10 |