| NPI | 1578628657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: WA OP60354605) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA OP60354605) |
| 207Q00000X Family Medicine (Licence: WA OP60354605) | |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: WA OP60354605) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2020-01-15 |