| NPI | 1962856641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP61135020) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR 8125198) |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2021-10-19 |