| NPI | 1174662100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60017650) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA MD60017650) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2017-03-21 |