| NPI | 1306834544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60187982) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME47952) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: WA MD60187982) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: FL ME47952) | |
| 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: WA MD60187982) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2018-10-23 |