NPI | 1811556418 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 200010) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 1600036) |
207Q00000X Family Medicine (Licence: NC 2024-00183) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-06-07 |
Last Update Date | 2025-08-18 |