| NPI | 1932620739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61022938) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA OP61022938) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 227072) | |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2021-11-11 |