| NPI | 1740671148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60859647) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 29450) |
| Enumeration Date | 2015-02-07 |
| Last Update Date | 2019-05-16 |