| NPI | 1679193635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP61441059) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR PG199123) |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2023-10-12 |