| NPI | 1427342591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60359582) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA ML60224813) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2016-02-01 |