| NPI | 1093330599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: WA MD61404020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61404020) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2024-09-12 |