| NPI | 1740983253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD70023551) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA MD70023551) |
| Enumeration Date | 2023-03-23 |
| Last Update Date | 2025-09-13 |