| NPI | 1659300374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: WA MD00046152) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00046152) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2024-02-13 |