| NPI | 1629573548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 20A17786) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 20A17786) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-25 |
| Last Update Date | 2023-06-20 |