| NPI | 1205891637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP00002175) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: ME 1226) |
| 207Q00000X Family Medicine (Licence: ME 1226) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2021-03-31 |