| NPI | 1851887384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A153516) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A153516) |
| 261QU0200X Clinic/Center, Urgent Care (Licence: CA A153516) | |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2021-12-23 |