NPI | 1437730652 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 23409) |
Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101027547) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-04-19 |
Last Update Date | 2024-10-08 |