| NPI | 1700327541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CA 158157) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 158157) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2024-06-12 |