| NPI | 1992053011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60958120) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: WA MD60958120) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2026-03-17 |