| NPI | 1538110911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WA OP61069996) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 1198) |
| 207Q00000X Family Medicine (Licence: NE 1198) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2021-01-07 |