| NPI | 1841499498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA MD60657392) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60657392) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2022-04-21 |