| NPI | 1538204649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: WA MD00031618) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-9021) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2022-09-28 |