| NPI | 1619946217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 464) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA OP0002319) |
| 207Q00000X Family Medicine (Licence: WA OP00002319) | |
| 208D00000X General Practice (Licence: WA OP0002319) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2020-03-17 |