| NPI | 1588169312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A167044) |
| Enumeration Date | 2018-03-25 |
| Last Update Date | 2023-06-27 |