| NPI | 1992386429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61551144) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: WA MD61551144) |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2026-02-27 |