| NPI | 1912636101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A202298) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2023-1164) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2025-07-10 |