| NPI | 1669614418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60593091) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD 60593091) |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2019-11-14 |