| NPI | 1356341358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00042410) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: WA MD00042410) |
| 207Q00000X Family Medicine (Licence: WA 582682243) | |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2025-05-21 |