| NPI | 1689601361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: WA MD00037272) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00037272) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2020-07-10 |