| NPI | 1487281614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080H0002X Pediatrics, Hospice and Palliative Medicine (Licence: WA MD61691111) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2025-07-14 |