| NPI | 1497315592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS19625) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OL61061701) |
| 207Q00000X Family Medicine (Licence: WA OP61428186) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2023-09-07 |