| NPI | 1902689979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA DO.OP.70105570) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: WA DO.OP.70105570) |
| 207Q00000X Family Medicine (Licence: WI 100507-851) | |
| Enumeration Date | 2023-08-15 |
| Last Update Date | 2026-07-17 |