| NPI | 1881011963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 138787) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 383331) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2019-06-27 |