| NPI | 1790277507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A178825) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX BP10073794) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2024-01-19 |