| NPI | 1518900950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00045715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 20279) |
| 207Q00000X Family Medicine (Licence: WA MD00045715) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2010-08-24 |