| NPI | 1629484464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA OL60479567) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60769815) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2022-07-21 |