| NPI | 1861889354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: WA 60786763) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A157398) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 207Q00000X Family Medicine (Licence: WA 60786763) | |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2025-11-26 |