| NPI | 1063823375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60729591) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60729591) |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2025-09-10 |