| NPI | 1679512487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA MD00039345) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00039345) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2022-07-27 |