| NPI | 1508809955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00019301) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: WA MD00019301) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WA MD00019301) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2015-01-31 |