| NPI | 1477744290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A101553) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA A101553) | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2011-06-21 |