| NPI | 1518104173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A126123) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101245984) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116020361) | |
| Enumeration Date | 2009-01-19 |
| Last Update Date | 2020-07-22 |