| NPI | 1417303793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 96797) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60969576) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2021-06-22 |