| NPI | 1194726851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 60114769) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA 60114769) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2024-10-31 |