| NPI | 1821040247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00037693) |
| Additional Taxonomies | 2083A0300X Preventive Medicine Addiction Medicine (Licence: WA MD00037693) |
| 207P00000X Emergency Medicine (Licence: ID M-9219) | |
| 207Q00000X Family Medicine (Licence: ID M-9219) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2025-05-29 |