| NPI | 1689789042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA MD00041647) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR 15368) |
| 208D00000X General Practice (Licence: OR MD15368) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2021-01-04 |