| NPI | 1396739967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA 15075) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA 15075) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2009-08-06 |