| NPI | 1265576292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: UT 12994430-1205) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 183500000X Pharmacist (Licence: WA Ph00039885) | |
| 208D00000X General Practice (Licence: WA MD60502221) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2022-08-23 |