| NPI | 1023598265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: WA PA60999283) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA PA60999283) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2024-05-01 |