| NPI | 1154588978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP 60024772) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WA OP 60024772) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2018-01-10 |