| NPI | 1053554154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60199411) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: WA OP60199411) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2021-10-27 |