| NPI | 1902509912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 202D00000X Integrative Medicine (Licence: CA A200526) |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2026-04-10 |