| NPI | 1669415881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: UT 6453925-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD23225) |
| 208D00000X General Practice (Licence: WA MD23225) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2018-07-18 |