| NPI | 1285790022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60229817) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60229817) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2014-02-12 |