| NPI | 1841878634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 181578) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2022-09-12 |