| NPI | 1326434531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60857565) |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2018-06-27 |