| NPI | 1225528987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP61166338) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR PG188435) |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2023-03-24 |