| NPI | 1215905245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: WA OP716) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: WA OP716) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2018-11-02 |