| NPI | 1285014571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61165771) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: WA OP61165771) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2021-09-15 |