| NPI | 1841867439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A192125) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA PTL7591) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA PTL7591) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2024-09-25 |