| NPI | 1821726548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 20A22089) |
| Enumeration Date | 2022-08-10 |
| Last Update Date | 2024-05-09 |