| NPI | 1568091841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A184266) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 23299) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2026-08-14 |