| NPI | 1003887720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60249293) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: WA 60249293) |
| 208D00000X General Practice (Licence: WI 48844-020) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2025-08-26 |