| NPI | 1194760769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA MD00030462) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00030462) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2007-11-01 |