| NPI | 1972766855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CO61669207) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MA00020790) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2025-07-31 |