| NPI | 1275788770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA MD60294677) |
| Additional Taxonomies | 1744R1102X Specialist, Research Study (Licence: WA 60294677) |
| 208D00000X General Practice (Licence: WA MD.60294677) | |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2020-10-16 |