| NPI | 1740385863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD22791) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00028704) |
| 174400000X Specialist (Licence: OR MD22791) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2023-08-30 |