| NPI | 1811473655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61440957) |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2023-06-30 |