| NPI | 1225047566 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00036567) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00036567) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2022-11-07 |