| NPI | 1750467551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00038802) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00038802) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2012-05-03 |