| NPI | 1306158779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60294402) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60294402) |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2014-02-13 |