| NPI | 1548958812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS23959) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OL61425321) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA OL61425321) | |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2026-07-10 |