| NPI | 1194784090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WA 2520900035733) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00035733) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2025-05-15 |