| NPI | 1851751523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 3660) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 3660) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2023-08-14 |