| NPI | 1205922879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: WA MD00041379) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00041379) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-11-18 |