| NPI | 1063819381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA OP61353218) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60523469) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2022-12-19 |