| NPI | 1033228655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 00028830) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA 00028830) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2019-06-19 |