| NPI | 1427359488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A116222) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A116222) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-11-08 |
| Last Update Date | 2017-03-17 |