NPI | 1770141004 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A20365) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2019-06-01 |
Last Update Date | 2022-11-28 |