| NPI | 1730187436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD22062) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD22062) |
| 207Q00000X Family Medicine (Licence: WA MD00039026) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2024-03-06 |