| NPI | 1285612879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60597143) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301046463) |
| 207Q00000X Family Medicine (Licence: WA MD60597143) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2016-01-13 |