| NPI | 1285071274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP60494291) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60494291) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2019-11-08 |