| NPI | 1497069918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 90879) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60323859) |
| 208D00000X General Practice (Licence: WA MD60323859) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2024-08-05 |