| NPI | 1922495035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO198260) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60709245) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA OL60568301) | |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2020-08-04 |