| NPI | 1861079246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT Med-Res-Lic-118538) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML61164300) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2023-03-20 |