NPI | 1952966012 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: CA A183095) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 250630) |
Enumeration Date | 2019-05-04 |
Last Update Date | 2024-02-20 |