| NPI | 1992383392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD220321) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 1992383392) |
| 208D00000X General Practice (Licence: CA 1992383392) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2024-07-17 |