| NPI | 1801047998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A117506) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 2730) |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2018-11-02 |