| NPI | 1063671147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60058256) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60058256) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA ML20008800) | |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2025-09-10 |