| NPI | 1497066211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60301737) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60301737) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2021-05-18 |