| NPI | 1730128893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: WA MD00039433) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00039433) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2022-02-10 |