| NPI | 1851889166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: WA MD61157038) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: WA MS61157038) | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2022-12-16 |