| NPI | 1871983189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ACN1389) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 15605i) | |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2022-06-06 |