| NPI | 1578060901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61666076) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A173515) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA PTL36) | |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2025-09-16 |