| NPI | 1740983428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA OP61641794) |
| Enumeration Date | 2023-03-23 |
| Last Update Date | 2025-08-15 |