| NPI | 1013610005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD.MD.61690830) |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2026-04-23 |