| NPI | 1316441447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61069893) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WA MD61069893) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: WA MD61069893) | |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2025-07-31 |