| NPI | 1174012355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61130110) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61130110) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2023-03-24 |