| NPI | 1083298608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61582363) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WA MD61582363) |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2025-07-17 |