| NPI | 1689825788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61387268) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: WA MD61387268) |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2025-11-20 |