| NPI | 1003336686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA ML60770411) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60770411) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2022-02-04 |