| NPI | 1568809465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 83810) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA OP60591635) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208600000X Surgery (Licence: WA OP60591635) | |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2024-05-01 |