| NPI | 1063453595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60118970) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60118970) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 067375) | |
| 208D00000X General Practice (Licence: WA MD60118970) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2023-02-20 |