| NPI | 1023883162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202D00000X Integrative Medicine (Licence: WA AP61504919) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: WA AP61504919) |
| Enumeration Date | 2023-11-20 |
| Last Update Date | 2023-11-20 |