| NPI | 1831162940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: WA OP60656371) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60656371) |
| 207Q00000X Family Medicine (Licence: GA 48635) | |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2023-03-07 |