| NPI | 1780978601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: WA MD60628117) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: OR MD200214) |
| 208D00000X General Practice (Licence: WA MD60628117) | |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2026-07-17 |