| NPI | 1518525435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A200848) |
| 207Q00000X Family Medicine (Licence: CA A200848) | |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2026-07-21 |