| NPI | 1669494217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61140126) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO DR.0054315) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2025-09-03 |