| NPI | 1437807039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 20A22029) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 20A22029) |
| Enumeration Date | 2022-03-13 |
| Last Update Date | 2024-12-06 |