| NPI | 1992065460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60536083) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 71686) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2021-05-25 |