NPI | 1902556855 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: CA A189934) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A189934) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2022-03-24 |
Last Update Date | 2025-07-28 |