| NPI | 1114510849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: WA OP61333637) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA OP61333637) |
| Enumeration Date | 2021-02-13 |
| Last Update Date | 2024-09-13 |