| NPI | 1144269960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00046149) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD11631) |
| 207P00000X Emergency Medicine (Licence: WA MD00046149) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2008-09-30 |