| NPI | 1801472501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A193843) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA A193843) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: 39) | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2024-05-08 |