| NPI | 1235988569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA OL61544798) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA FH4359279) |
| Enumeration Date | 2024-05-17 |
| Last Update Date | 2025-10-27 |