| NPI | 1508966185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA MD00023013) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00023013) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2010-02-08 |