| NPI | 1457975005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA ML61064759) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML61064759) |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2020-07-24 |