| NPI | 1407344872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD206293) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: WA MD61188750) | |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2026-07-08 |