| NPI | 1528087335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00035859) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD18701) |
| 207P00000X Emergency Medicine (Licence: WA MD00035859) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2025-03-24 |